Safety and Feasibility of Out-of-Bed Mobilization for Patients With External Ventricular Drains in a Neurosurgical Intensive Care Unit

Abstract

Introduction: Prolonged bed rest is a frequent problem for patients with critical illness that may negatively impact survival, quality of life, and medical care cost. Patients with critical neurologic problems are often kept on bed rest or only cleared to perform bed-based activities because of the inherent risk of displacing or damaging intracranial monitoring devices such as the external ventricular drains (EVDs) during activity. Specific recommendations for out-of-bed (OOB) mobilization of such patients are lacking. Purpose: To review the occurrence of adverse events related to OOB mobilization in patients with EVDs. Methods: This was a retrospective study. Data from all adult patients with an EVD and medical clearance for OOB physical therapy (PT) from October 2014 to November 2016 were analyzed. Results: Eighteen patients with EVDs received 108 interventions of OOB PT sessions during this period. No catheter-related mechanical complications occurred during or immediately following the sessions. No serious adverse events were recorded. Minor adverse events included transient dizziness, headache, episodes of hypertension, and hypotension. Vital signs showed no clinically relevant variations before and after the sessions. Conclusions: OOB mobilization was feasible and safe in this group of patients. The effect on morbidity and survival should be further investigated in a larger prospective study.